How Part D Works With Other Insurance
The types of insurance listed below are all considered
. If you have one of these types of insurance, in most cases, it will be to your advantage to keep your current coverage.
Keep any creditable prescription drug coverage information you get from your plan. You may need it if you decide to join a Medicare drug plan later. Don’t send creditable coverage letters/certificates to Medicare.
If Your Or Your Spouse’s Employer Has 20 Or More Employees Then The Group Health Plan Pays First And Medicare Pays Second
didn’t pay all of your bill, the doctor or
should send the bill to Medicare for secondary payment. Medicare will pay based on what the group health plan paid, what the group health plan allowed, and what the doctor or health care provider charged on the claim. You’ll have to pay any costs Medicare or the group health plan doesn’t cover.
Employers with 20 or more employees must offer current employees 65 and older the same health benefits, under the same conditions, that they offer employees under 65. If the employer offers coverage to spouses, they must offer the same coverage to spouses 65 and older that they offer to spouses under 65.
How Much Does Medicare Part B Cost
The out-of-pocket costs for Part B include a premium, deductible, and coinsurance. Part B will cover 80% of your medical expenses once youve met the annual deductible. You must pay the monthly premium for Part B. Most beneficiaries will pay the standard monthly premium. Those in a higher income bracket will pay more.
In 2022, the Part B premium is $170.10 a month. If you receive Social Security, Railroad Retirement Board, or Office of Personnel Management benefit payments, your Part B premium will be deducted from your monthly check. Part B has an annual deductible of $233. This deductible can slightly increase each year.
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You Need Part B If Medicare Is Primary
What is Medicare Part B? It is your outpatient coverage.
Once you retire and have no access to other health coverage, Medicare becomes your primary insurance. Part A pays for your room and board in the hospital. Part B covers most of the rest.
The Medicare definition for Part B is outpatient coverage. However, Part B covers many things that happen both in and out of the hospital. Part B provides 80% coverage for doctor visits, labwork, physical therapy, medical equipment, diabetes supplies, surgeries, chemotherapy, radiation, dialysis and much more.
Is Medicare Part B optional? Yes, because some people who are still working may wish to delay it until they retire.
However, it is a critical component of your overall health package when Medicare is primary.
Some common scenarios where Medicare is primary are:
- When you are 65 or older and have employer coverage at a company with less than 20 employees
- When you are under 65 on Medicare due disability and work for an employer with less than 100 employees
- If you have retiree coverage from a former employer
- With COBRA insurance, you must enroll in Part B by the 8th month of COBRA
- When you are turning 65 with Tricare for Life or CHAMPVA
- When you are 65 or older and enrolled in Medicaid
Employer coverage, retiree coverage, COBRA, TFL and Medicaid all function as your secondary insurance only if do your part and first enroll in Part B. Failure to enroll in Part B means you will also owe a penalty if you decide to enroll later on.
Enrolling Into Part B On A Delayed Basis
If you have delayed Part B while you were still working at a large employer, youll still need to enroll in Part B eventually. When you retire and lose your employer coverage, youll be given a 8-month Special Enrollment Period to enroll in Part B without any late penalty.
You should set up Part B to start the very next day after you lose your employer coverage. For example, if you know you will be retiring on June 30th, you should enroll in Medicare Parts A and/or B to begin on July 1st.
When you activate your Part B, you will activate your 6-month Medicare supplement open enrollment window. This is your one opportunity to enroll into any Medigap plan without health questions. Once the 6 month window expires, its gone forever. If Medigap is too expensive and you prefer a Medicare Advantage plan, you have a short window to also enroll into a Medicare Advantage plan using a Special Election Period. These are tricky, so always work with an agent who specializes in Medicare to set that up properly.
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Why Is It Important To Receive A Vaccination Against Shingles
About 33% of adults in the U.S. will develop shingles at some point in their lives. Shingles can cause painful blisters, a rash, chills, and fever, among other symptoms. Many people who have shingles later develop PHN, which can cause long-lasting pain that is difficult to treat.
Getting the Shingrix vaccine can help individuals avoid shingles and PHN and help prevent shingles from spreading to vulnerable people.
Sign Up: Within 8 Months After The Active Duty Service Member Retires
- Most people dont have to pay a premium for Part A . So, you might want to sign up for Part A when you turn 65, even if the active duty service member is still working.
- Youll pay a monthly premium for Part B , so you might want to wait to sign up for Part B.
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
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Medicare Supplement Plans: What Is Medigap
Medigap is one of the most common ways to supplement Medicare. This is a standardized, regulated health plan that pays part of the out-of-pocket medical costs for individuals insured by Medicare. All Medigap policies are offered by private health insurers, and theyre always coupled with Original Medicare.
Depending on where you live, you may have your choice of up 10 types of Medigap policies. Each has different levels of coverage, but all address cash expenses arising from Medicare, such as deductibles, copayments, and coinsurance. The types of Medigap policies are identified by letters and, with a few exceptions, all policies with the same letter must offer the same coverages. Those exceptions apply only in certain states. For example, in Massachusetts, Minnesota, and Wisconsin, Medigap plans are standardized differently. And some states may offer whats called Medicare SELECT. This is a lower cost plan that limits you to in-network healthcare providers.
You do pay a premium for Medigap coverage, which would be in addition to the premium youre paying for your Part B Medicare.
How To Sign Up For Medicare Part B
Beneficiaries collecting Social Security benefits when they age into Medicare at 65 will automatically be enrolled. Youll receive your Medicare card the month before your birthday. If youre not collecting Social Security benefits, youll need to enroll yourself. You can apply online, over the phone, or in-person.
All beneficiaries will have an Initial Enrollment Period for both Part A & Part B. This period begins three months before the month you turn 65th birthday and ends three months after. If you dont enroll during your Initial Enrollment Period and dont have , you could be subject to a penalty.
You wont pay the penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period. An example would be if you continued working past 65 and had creditable coverage through an employer group health insurance.
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What Happens If You Have Other Health Insurance Besides Medicare
Health insurers have policies in place to guide them when people have multiple health insurance plans. Its called COB, which protects insurance companies from making duplicate payments or even reimbursing for more than the healthcare services cost.
Insurance providers work together to coordinate benefits and they use COB policies to figure out who is the primary insurer and who is secondary:
- The primary insurer pays first and then the secondary reimburses what the primary insurer didnt cover up to 100% of the total cost of care, as long as the plan covers that service. Whatever is left after that is your responsibility.
Lets look at an example of how this would work if you had two health insurers. You go to the doctor and the services cost $200. The primary insurer pays its amount. Lets say thats $100. The secondary insurer then picks up its portion if the plan covers those services up to 100% of the total cost. The rest is on you if the doctor is still owed money.
If Medicare is the secondary payer and the primary insurer doesnt pay swiftly enough, Medicare will make conditional payments to a provider when there is evidence that the primary plan does not pay promptly. Medicares Benefits Coordination & Recovery Center then recovers conditional payments from the slow-paying insurer.
Your Medicare Special Enrollment Period
If your employer has at least 20 employees and youre still working and covered under that plan when you turn 65, you can delay your enrollment in Medicare . In that case, youll get an eight-month special enrollment period to sign up for Medicare if and when you leave your job or your employer stops offering coverage. It will start the month after you separate from your employer, or the month after your group health coverage ends whichever happens sooner.
Sign up during those eight months, and you wont have to worry about premium surcharges for being late. And the eight-month special enrollment period is also available if youre delaying Part B enrollment because youre covered under your spouses employer-sponsored plan, assuming their employer has at least 20 employees.
But note that in either case, it has to be a current employer. If youre covered under COBRA or a retiree plan, you wont avoid the Part B late enrollment penalty when you eventually enroll, and you wont have access to a special enrollment period to sign up for Part B youll have to wait for the general enrollment period instead.
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When Medicare Doesnt Pay
Medicare doesnt normally pay for medical services when other insurance entities would provide coverage instead. It might provide secondary coverage. This includes:
- Injuries related to auto accidents
- Third-party liability
- Work injury or illness
- Illness related to mining
However, if your claim is denied under these areas, Medicare will make payments to the extent that the services are covered under Medicare.
Reasons To Delay Medicare
If youre thinking about deferring Medicare, discuss the pros and cons with your current insurer, union representative, or employer. Its important to know how or if your current plan will work with Medicare, so you can choose the most comprehensive overage possible.
Some of the common reasons you may want to consider deferring Medicare include:
- You have a plan through an employer that you want to keep.
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Medicare Part C And Va Benefits
If you need additional services or coverage not offered to you through your VA benefits, you may consider a Medicare Advantage plan. Most Medicare Advantage plans offer additional coverage, like vision, hearing, dental, prescription drug coverage, and/or health and wellness programs. These services are usually offered through your VA benefits too, however, a Medicare Advantage plan might be a better choice depending on the facility locations and your travel needs. Learn more about Medicare Part C.
Do I Need Medicare Part B If I Have Retiree Insurance
It depends on the type of insurance an individual has. If the insurance is a COBRA or individual policy, or retiree coverage provided by a union or employer, enrollment in both Part A, hospital insurance, and Part B, medical insurance, is necessary. These types of insurance are secondary to Medicare, paying for any covered care after Medicare has paid its share.
But if the insurance comes through current employment of either the beneficiary or his or her spouse with a large employer , Medicare recommends enrollment in premium-free Part A. Part B enrollment is not necessary. When this coverage ends, Medicare provides special periods to enroll in Part B and obtain other coverage, such as a Part D prescription drug plan, a Medigap policy, or a Medicare Advantage plan.
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How To Apply Online For Just Medicare
If you are within three months of turning age 65 or older and not ready to start your monthly Social Security benefits yet, you can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later. It takes less than 10 minutes, and there are no forms to sign and usually no documentation is required.
To find out what documents and information you need to apply, go to the .
Who Is The Primary Insurer Your Group Plan Or Medicare
When health insurance claims are filed, there is typically a primary insurer and a secondary insurer . Whether or not you should enroll in Part B depends on who is the primary insurer, Medicare or your group plan. How do you know? The number of people employed at your company is the deciding factor.
In companies with less than 20 employees: Medicare automatically becomes the primary insurer, with group insurance second. In this case, you should take Part A and Part B when you are first eligible. Why? If your employer is a secondary insurer, they pay after Medicare pays. By delaying Medicare benefits, you wont have a primary insurer, and what you pay out-of-pocket will be high.
In companies with more than 20 employees: Your employer becomes the primary insurer, with Medicare coverage second. In this case, you can delay enrolling in Part B as your group coverage will pay your medical claims.
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Medicare Part D And Va Benefits
You can have both VA prescription drug benefits and a Medicare prescription Part D drug plan, however you may not need one. With VA health benefits, you typically get premium-free drug coverage. However, if the VA-approved pharmacy locations or the Consolidated Mail Outpatient Pharmacy Program , doesnt work for you, then you may consider a Part D or a Part C plan with prescription drug coverage. Part D coverage may also work for your needs if you qualify for Extra Help or if your nursing home is outside of the VA health system and you need medications from the nursing home pharmacy. If you choose to enroll in Part D at a later time, you can do so without paying a penalty. Learn more about Medicare Part D.
If The Employer Has 20 Or More Employees
As long as you have group health insurance from an employer for which you or your spouse actively works after you turn 65, you can delay enrolling in Medicare until the employment ends or the coverage stops , without incurring any late penalties if you enroll later. When the employer-tied coverage ends, youre entitled to a special enrollment period of up to eight months to sign up for Medicare.
Note that “active employment” is the key phrase here. You cant delay Medicare enrollment without penalty if your employer-sponsored coverage comes from retiree benefits or COBRA by definition, these do not count as active employment.
Nor does it count if you work beyond 65 but rely on retiree benefits from a former employer. You must be actively working for the employer that currently provides your health insurance in order to delay Medicare enrollment and qualify for a special enrollment period later on.
The law requires a large employer one with at least 20 employees to offer you the same benefits that it offers to younger employees . It is entirely your choice whether to:
- accept the employer health plan and delay Medicare enrollment
- have the employer coverage and Medicare at the same time
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Who Is Eligible For Medicare
Typically, anyone age 65 or older is eligible for Medicare. Younger people may also be eligible for Medicare if they have disabilities, end-stage renal disease, or amyotrophic lateral sclerosis . Anyone who starts collecting Social Security benefits at least 4 months before turning 65 will automatically be enrolled in Medicare Parts A and B.
You Need Part B To Be Eligible For Supplemental Coverage
Medigap plans do not replace Part B. They pay secondary to Part B.
Part B works together with your Medigap plan to provide you full coverage. This means you must be enrolled in Part B before you are even eligible to apply for a Medicare supplement. Your healthcare providers will bill Medicare, and Part B will then pay 80% of your outpatient expenses after your small deductible. Medicare then sends the remainder of that bill to your Medigap plan to pay the other 20%.
The same goes for Medicare Advantage plans. You are not eligible for a Medicare Advantage plan unless you are enrolled in both Medicare Parts A and B and live in the plans service area.
On the flip side, having ONLY Parts A and B with no secondary coverage is also very risky. It leaves you exposed to paying 20%, unending, or some very expensive items. For example, if you needed a knee replacement and had only Medicare, you would pay 20%. A surgery like that might cost in excess of $100,000. Dont be left holding a bill for 20% of that.
My advice: You should enroll in both Part B and either a Medigap plan or Medicare Advantage plan.
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